Worcester County Local Health Improvement Process

Public Health Assessment and Wellness

Choosing And Maintaining Programs for Sex Education in Schools (CHAMPSS)

State: TX
Type: Model Practice
Year: 2014

ABSTRACT:

The goal of the CHoosing And Maintaining Programs for Sex education in Schools (CHAMPSS) project is to assist the 21 Independent School Districts (ISDs) in Harris County, Texas to adopt, implement, and maintain an evidence-based program (EBP) designed to reduce the teen pregnancy rate by changing risky sexual behaviors such as lack of condom/contraception use or early sexual initiation. School districts often struggle with adoption of a program that best fits their needs and find the process of gaining support from key stakeholders to be controversial and difficult. Using the CHAMPSS model, ISDs will be able to increase adoption, implementation, and maintenance of EBPs, while learning strategies to reduce barriers.

ORGANIZATION:

Harris County Public Health and Environmental Services

TITLE:

Choosing And Maintaining Programs for Sex Education in Schools (CHAMPSS)

Harris County Public Health and Environmental Services (HCPHES) is a comprehensive local health department serving the third most populous county, Harris County, Texas in the United States. It spans over 1700 square miles with a land area larger than the state of Rhode Island. HCPHES’ jurisdiction includes approximately 2 million people within Harris County’s unincorporated areas and over 30 small municipalities located in Harris County, Texas (not including the city of Houston). For certain public health services the HCPHES jurisdiction encompasses the entire county including the city of Houston, therefore providing services to over 4 million people in total. The mission statement of HPCHES is “Promoting a Healthy and Safe Community, Preventing Illness and Injury, Protecting You, HCPHES, Your Department for Life”. Across the broad organizational framework, HCPHES has engaged in significant departmental strategic planning activities which include the HCPHES Strategic Plan 2013-2018. This plan states that HCPHES will employ evidence-base and best practices to address priority public health issues which include intentional and unintentional injuries.Describe public health issue: According to the National Campaign to Prevent Teen Pregnancy (NCPTP) and the University of Texas Prevention Research Center (UTPRC), Texas teen birth rates (63 per 1,000 females ages 15-19) are amongst the highest in the nation, costing Texas over $1 billion each year. Teen pregnancy and parenthood is a key reason cited by teen girls who drop out of high school prior to graduation, with about 40% finishing high school, according to the NCPTP. High school dropout has been described as a “major public health challenge” by BMC Public Health, and it was found that students who dropout are at an increased risk of sickness and disability later in adulthood.
Goals and Objectives for CHAMPSS: The goal of the CHoosing And Maintaining Programs for Sex education in Schools (CHAMPSS) project is to assist the 21 Independent School Districts (ISDs) in Harris County, Texas to adopt, implement, and maintain an evidence-based program (EBP) designed to reduce the teen pregnancy rate by changing risky sexual behaviors such as lack of condom/contraception use or early sexual initiation. School districts often struggle with adoption of a program that best fits their needs and find the process of gaining support from key stakeholders to be controversial and difficult. Using the CHAMPSS model, ISDs will be able to increase adoption, implementation, and maintenance of EBPs, while learning strategies to reduce barriers.
Outcome Objectives: District/school professionals participating the CHAMPSS project will: 1) increase awareness of the issue of teen pregnancy in their School Health Advisory Council (SHAC), administrators, and parents; 2) develop or improve their skills with selecting, gaining support, planning, implementing and maintaining an evidence-based sex education program for their district; and 3) increase their ability to make change happen in their school/district related to teen pregnancy prevention.
The CHAMPSS project began in 2011. Essentially, it is a series meetings (5-6) throughout the school year. Each meeting is based on a stage of the CHAMPSS model (see Figure 1). Each step has key strategies that should occur within a district prior to the next step. During the meetings, participants learn the how to use the tools and techniques for each given step/stage of the model.
Key components of each meeting include: dissemination of relevant information to increase knowledge of teen pregnancy, skill-building activities, and networking opportunities. Materials are presented to the members through large and small group activities, PowerPoint presentations, and training workshops. Some of the specific skill-building content presented to members includes: meeting the challenges of adolescent sexual health in Harris County ISDs; differentiating myths from facts on adolescent sexual health information; selecting an EBP; learning how to obtain useful data and effectively disseminating it to the public; developing effective arguments to respond to others in support of evidence-based sex education; and writing SMART goal and objectives.Results/Outcomes: The process milestones associated with the CHAMPSS project were:
1. Identify districts’ interest in participating2. Determine each districts’ stage in the CHAMPSS model 3. Coordinate and facilitate at least 4 meetings a school year 4. Conduct quantitative evaluation annually to determine any change (by districts) in stage of CHAMPSS model
Each of the process milestones were accomplished since the inception of the project. Specific factors that led to the success of CHAMPSS were directly related to the stakeholders’ interests in the project and relationships established between them.

HCPHES is a comprehensive LHD serving the third most populous county, Harris County, Texas, in the United States. It spans over 1700 square miles and its land area is larger than the state of Rhode Island. HCPHES’ jurisdiction includes approximately 2 million people within Harris County’s unincorporated areas and over 30 small municipalities located in Harris County (not including the city of Houston). The population of Harris County consists of urban, sub-urban and rural areas.Statement of the problem/public health issue: According to the National Campaign to Prevent Teen Pregnancy (NCPTP) and the University of Texas Prevention Research Center (UTPRC), Texas teen birth rates (63 per 1,000 females ages 15-19) are amongst the highest in the nation, costing Texas over $1 billion each year. In Harris County, 49% of all high school students reported being sexually experienced according to the Youth Risk Behavior Survey. Teen pregnancy and parenthood is a key reason cited by teen girls who drop out of high school prior to graduation, with about 40% finishing high school, according to the NCPTP. High school dropout has been described as a “major public health challenge” by BMC Public Health, and it was found that students who dropout are at an increased risk of sickness and disability later in adulthood.
Target population: The target population of the CHAMPSS project is the 21 Harris County ISDs (with a potential reach of approximately 1 million public school students). They vary in size from serving approximately 3,000 to 200,000 student is urban and rural areas of Harris County.
Percentage reached: 15 Harris County ISDs participated in the CHAMPSS project, representing 71% of Harris County ISDs.
What had been done in the past to address the problem: HCPHES has successfully established relationships with ISDs to address other school health issues through the Harris County School Health Leadership Group (SHLG). This was the first effort by HCPHES to address teen pregnancy by working with the ISDs from the district level. Other approaches to address teen pregnancy were predominately community and/or after-school type programs where the target audience was students.
Why is current practice better?
Systems-based change is a well-documented method for changing environments, programs and policy within a school system. The approach that was developed by UTPRC was based on systems change theory. The CHAMPSS project was operationalized by teaching district stakeholders how to work through each phase of the process resulting in maintenance of an EBPs. This practice works because it includes getting essential stakeholder buy-in to the overall process a school district must go through to select, adopt, plan, implement and maintain an EBP to address adolescent sexual health (or any program related to health).
The CHAMPSS project is innovative and addresses teen pregnancy from a theoretical perspective that involves multiple levels of stakeholders within a school district. It relies on the district to be the “do-er” of the work.
The CHAMPSS project is based on a model developed by the UTPRC following Intervention Mapping matrices (with input from HCPHES staff). According to UTPRC, the framework outlines the steps and tasks needed for schools to adopt, implement, and maintain EBPs. UTPRC describes the CHAMPSS model as “encompassing the phases of adoption, implementation, and maintenance, the CHAMPSS model comprises seven steps: Prioritize, Asses, Select, Approve, Prepare, Implement, and Maintain (Figure 1). Getting Others On Board—i.e., forming linkages with other supporters of EBPs and adolescent sexual health—is a fundamental element in the model that extends across all steps. Each step is further divided into 2–6 critical tasks, including generating support from others. For more information about the development of the CHAMPSS model, see http://digitalcommons.library.tmc.edu/childrenatrisk/vol2/iss2/7/.” attachment-Figure 1. The CHAMPSS model, “round”

Teen Pregnancy

Goals and objectives of practice The goal of the CHoosing And Maintaining Programs for Sex education in Schools (CHAMPSS) project is to assist the 21 Independent School Districts (ISDs) in Harris County, Texas to adopt, implement, and maintain an evidence-based program (EBP) designed to reduce the teen pregnancy rate by changing risky sexual behaviors such as lack of condom/contraception use or early sexual initiation. School districts often struggle with adoption of a program that best fits their needs and find the process of gaining support from key stakeholders to be controversial and difficult. Using the CHAMPSS model, ISDs will be able to increase adoption, implementation, and maintenance of EBPs, while learning strategies to reduce barriers.Outcome Objectives: District/school professionals participating in the CHAMPSS project will: 1) increase awareness of the teen pregnancy issue to their School Health Advisory Council (SHAC), administrators, and parents; 2) develop or improve their skills with selecting, gaining support, planning, implementing and maintaining an evidence-based sex education programs for their district; and 3) increase their ability to make change happen in their school/district related to teen pregnancy prevention.
HCPHES coordinated and facilitated 5-6, 2-3 hour meetings with school district stakeholders, including parents and community members, who were interested in addressing adolescent sexual health in their school districts. The specific criteria for this project were that participating districts must be located in Harris County, Texas. Each meeting was dedicated to addressing a particular stage of the CHAMPSS model. Information about each stage was presented to include addressing who would be involved, who would resist, strategies to engage others, tools and techniques needed, etc.
Stages (per UTPRC’s CHAMPSS Model):
Assess the state of sexual health and support for sexual health education in your district
Select an effective sexual health education curriculum
Obtain school board approval of an effective sexual health education curriculum
Prepare to implement a sexual health education curriculum
Implement an effective sexual health education curriculum with fidelity
Maintain the use of an effective sexual health education curriculum in your district
Get others on board with supporting effective sexual health education in your district
At the beginning of each meeting, participants were asked to identify which stage their district was in as it related to adoption, implementation, and maintenance of an EBP. This was visually represented using laminated school buses with each districts’ name and then posted on a banner representing the model (see Figure 2-Bus Movement on the CHAMPSS Model)
The CHAMPSS group is operated based on the schools’ schedule starting in September and finishing in May. This project began in 2011 and it still occurring. Each school year, each phase of the process, along with the specific steps and skills and/or tools necessary to accomplish those steps are presented.Were other stakeholders involved? Over the past thirteen years, HCPHES and the Office of Health Education and Promotion have collaborated with the University of Texas Prevention Research Center (UTPRC) and supported its research and dissemination endeavors. We have worked together to disseminate effective health education programs throughout Harris County’s 21 Independent School Districts. Through our partnership with the UTPRC, we successfully conducted the Harris County Youth Risk Behavior Survey (YRBS), over multiple years, with a representative sample of students in school districts in Harris County.
UTPRC was a stakeholder in the CHAMPSS project. They provided funding for a staff coordinator as well as funds for materials for the meetings, to include lunch during the meetings. UTPRC also provided expertise related to the topic. HCPHES worked directly with UTPRC throughout planning and implementation of the entire project. In return, HCPHES provided vital feedback to UTPRC for their web-based iCHAMPSS model, which is in development. Other stakeholders in the projects were the Harris County ISDs. HCPHES maintains strong relationships with the ISDs and were able to leverage the existing trust they had with us to encourage participation. UTPRC’s roles are to provide content expertise in adolescent sexual health through presentations, collaborate with HCPHES in developing creating skill-building activities, and providing resources. Those served by the practice include: district-level health/physical education coordinators, district-level secondary science coordinators, district-level health services coordinators, district-level guidance counselor coordinator, school-level health/physical education teachers, school nurses, school guidance counselors, School Health Advisory Committee (SHAC) coordinator, and parents.
Any start up or in-kind costs and funding services associated with this practice? Funding for a less than part-time project coordinator were provided for UTPRC. HCPHES provided overall project direction using existing staff familiar with Harris County ISDs. Additional costs associated with mainly related to office supplies necessary for meetings and food, which was provided since most meetings spanned the lunchtime period. Estimated expenses outside of staff equal less than $1000 per school year.

The goal of the CHoosing And Maintaining Programs for Sex education in Schools (CHAMPSS) project is to assist the 21 Independent School Districts (ISDs) in Harris County, Texas to adopt, implement, and maintain an evidence-based program (EBP) designed to reduce the teen pregnancy rate by changing risky sexual behaviors such as lack of condom/contraception use or early sexual initiation. School districts often struggle with adoption of a program that best fits their needs and find the process of gaining support from key stakeholders to be controversial and difficult. Using the CHAMPSS model, ISDs will be able to increase adoption, implementation, and maintenance of EBPs, while learning strategies to reduce barriers.Outcome Objectives: District/school professionals participating the CHAMPSS project will:
1) increase awareness of the issue of teen pregnancy in their School Health Advisory Council (SHAC), administrators, and parents;
2) develop or improve their skills with selecting, gaining support, planning, implementing and maintaining an evidence-based sex education program for their district; and
3) increase their ability to make change happen in their school/district related to teen pregnancy prevention.
Survey Methods and Results: In the spring school semester of 2013, HCPHES conducted a quantitative survey using an online survey tool. Twenty-two (22) active CHAMPSS participants were polled. 73% of respondents completed the survey, representing 40% of Harris County ISDs. Most of the participants were district-level administrators or coordinators and one respondent was a parent who was an active member on the school district’s School Health Advisory Council (SHAC). Historical records gathered via qualitative methods unrelated to CHAMPSS in earlier years were used for comparison purposes. Results from the survey found:
• Almost 60% were confident that their district SHAC was addressing teen pregnancy prevention. Previously, few (less than an estimated 20%) district SHACs addressed the issue.
• 50% stated that their ISD placed a high priority level and 25% placed a moderate priority level on adopting and implementing an evidence-based teen pregnancy prevention program. This was up from a baseline of less than 25% when the CHAMPSS started.
• 33% stated that their ISD had conducted a needs assessment related to teen pregnancy prevention, 42% had not completed a needs assessment, and 25% were not sure if an assessment had been completed. This was an activity that was taught during a CHAMPSS meeting.
• 60% stated that their district SHAC had selected and recommended an EBP to their school board for implementation in their middle schools and 18% had done the same for their high schools. Twenty-five percent of respondents stated they weren’t certain. 100% of districts which had selected an EBP, stated they were using UTPRC’s, “It’s Your Game.”
• 42% stated that school had approved the selected and recommended EBP in middle school, 17% stated the program selected and recommended had been adopted in middle and high schools. 25% were not certain if program had been approved.
• 100% of respondents stated that they had approved a program stated that steps had been taken to prepare schools for implementation, to include development of an implementation plan (33%), instructors identified (33%), and tailoring of program to fit district’s needs (50%) had occurred. 56% skipped this question.
• 86% of respondents stated that their district had completed training and begun implementation of the approved EBP in middle schools and 14% had training planned soon. 2 districts reported that implementation had begun in their high schools. 56% skipped this question.
Participants, by district, were also asked to state which stage of the model they believe their district to be in at the given date. 8 unique districts stated that they were in a stage of the CHAMPSS model that was farther along than before they participated in CHAMPSS. 2 districts stated that they moved from outside the model (not even thinking about adolescent sexual health) into the model (Prioritize). When asked why they thought such movement occurred, they directly credited participation in the CHAMPSS project.Limitations: Multiple limitations existed as a result of the select form of evaluation. Limited resources (staff time and funding) did not allow for more extensive evaluation measures to be taken. While the survey tool did not directly assess the stated objectives, it did assess the expectations and larger outcomes related to adoption, implementation and maintenance of EBPs that were designed for CHAMPSS. Additionally, the quantitative survey method selected did not allow for districts to complete one survey per district. Thus, in instances were multiple participants (usually 2) from one district completed the survey, the results for that district may be skewed. Where possible, this factor was corrected and unique district responses were included in the results. Another limitation was that not all participants of CHAMPSS were able to receive the online survey due to ISD restricted internet sites.
Modifications: Using the information gathered during the evaluation along with follow-up anecdotal information received from participants, changes will be made for future meetings to include more skill-building activities and repetition of some more popular topics.

The CHAMPSS project strengthened the relationships HCPHES already had with Harris County ISDs. It has allowed a framework for other topics to be addressed with ISDs as well (nutrition and physical activity). Stakeholders (HCPHES, UTPRC and Harris County ISDs) are invested in the CHAMPSS project. While grant-funding is expected to end in 2015, it is anticipated that other funding will become available to allow this project to continue. However even without funding, this project could still continue as much of the success is contributed to the topical expertise of UTPRC staff and the relationships that HCPHES has developed with the ISDs. UTPRC, with input from HCPHES and ISDs, has developed a web-based CHAMPSS model (iCHAMPSS) that is designed to allow users to have an interactive experience and document their process for others in their district to see and contribute to. This web-based model will provide additional support for the in-person CHAMPSS meetings.